Authors (including presenting author) :
Kwok PY (1), Lai CK (1), Chan WL (2), Lai SY(1), Lam NK (1), Pang KS (1), Tai WH (1), Kwok WL Phyllis (1), YU KY (1)
Affiliation :
Adult Intensive Care Unit, Queen Mary Hospital (1)
Orthopedic rehabilitation unit, MacLehose Medical Rehabilitation Centre (2)
Introduction :
Oxygen therapy is commonly used in respiratory failure. However, lack of attentive oxygen management may expose patients to potential iatrogenic harm from hyperoxia.
Conservative oxygen strategy which targets at a lower oxygen saturation (SpO2) target in selective patient population has gained popularity in recent years. We describe the introduction of a protocol-driven oxygen titration programme for medically ill patients who received invasive mechanical ventilation in an adult intensive care unit (ICU) and related patient outcomes.
Objectives :
1. To explore feasibility of implementing oxygen titration for patients on invasive mechanical ventilation in ICU.
2. To raise ICU nurses’ awareness of the use of conservative oxygen strategy to alleviate potential harm of hyperoxia.
Methodology :
All medically ill patients on invasive mechanical ventilation were recruited unless contraindicated. Physiological parameters including SpO2 were monitored as per standardized practice. Fraction of inspired oxygen (FiO2) was titrated by nurses to maintain the SpO2 within a range according to pre-established protocol.
Desaturation was managed accordingly to ensure patient safety. Primary outcome was partial pressure of oxygen (PaO2) in arterial blood. Secondary outcomes included duration of mechanical ventilation with FiO2 at 0.21, episode of desaturation or incident, and staff compliance to the protocol.
Result & Outcome :
From September 2021 to August 2022, 484 patients underwent protocolized oxygen titration, compared with 771 patients receiving traditional oxygen administration strategy in September 2020 to August 2021. Both mean SpO2 and PaO2 were lower in oxygen-titration group respectively. (96.5 0.21% versus 97.2 0.29%; p < 0.05; (15.01 1.5 kPa versus 15.84 0.46 kPa; p < 0.05). Compared with traditional oxygen administration strategy group, those in oxygen titration group spent more time on FiO2 0.21 (30.1% 0.98% versus 25.1% 0.95%; p < 0.05). 77 patients (24.8% of the sample population) experienced transient drop in SpO2 beyond the set lower limit in oxygen-titration group. No serious incident or complication occurred during the protocol implementation period.
76.2% of the titration trial was performed at the pace set in the protocol. ICU nurses reflected that they had more confidence in performing oxygen titration after education and implementation of the protocol.
Conclusion
Oxygen titration programme can reduce oxygen use in mechanically ventilated patient and can be safely implemented in ICU setting. Follow-up beyond ICU setting is warranted to ascertain its effect on long term patient outcomes.
